It's Lonely Trying to Convince Chinese Hospitals to Go Smoke Free

Dr. Dan Xiao sits in a small office in a quiet corridor inside Beijing’s Chaoyang Hospital. As a doctor and medical researcher, her job is to convince 1.3 billion Chinese citizens that smoking is bad for their health. The room next to hers houses a national smoking-cessation hotline, a toll-free number that has been set up since 2004.

Over the course of an afternoon, the phone rings just once.

That might not be as troubling without another piece of information: China is home to somewhere between 300 and 350 million smokers. Cigarettes in China are cheap and plentiful, and many Chinese don’t even fully understand that smoking is likely to shorten their lifespans. There’s actually a popular myth that tobacco harms other nationalities, but not Chinese people, Xiao says. In 2009, the World Health Organization reported that only 37 percent of Chinese smokers knew that smoking caused heart disease.

There’s actually a popular myth that tobacco harms other nationalities, but not Chinese people.

Xiao’s battle is so steeply uphill that her first goal is to convince doctors that they should quit smoking. Up until only a few years ago, six out of ten Chinese doctors smoked. Today the rate is closer to 40 percent, a number that still brings to mind the U.S. of the 1940s and 1950s, when the majority of doctors smoked and cigarette companies used doctors in their advertisements.

Xiao’s second goal also has a quixotic feel: she wants to make all Chinese hospitals smoke-free. Chinese law required that all hospitals officially be smoke-free by the end of 2011, but that rule – like many in China concerning tobacco – has been laxly enforced. Xiao says that between 2008 and 2010, 40 hospitals in large cities have banned smoking inside their walls, compared to a total of more than 20,000 hospitals nationwide. "The local leading hospitals can set an example to other hospitals," she hopes.

China’s largest tobacco manufacturer is part of a perverse system that is both tobacco’s watchdog and guardian. The China National Tobacco Corp., which produces 2.3 trillion cigarettes a year, is a state-owned enterprise that is part of the State Tobacco Monopoly Administration, which in turn is part of the Ministry of Industry and Information Technology. A recent report from the U.S. National Institutes of Health noted that the China National Tobacco Corp. requires the local tobacco companies under its jurisdiction to produce a certain number of cheap cigarettes each year, and then subsidizes those companies to make up for lost profits. As a result, cigarettes in China cost as little as 5 RMB (80 cents) a pack.

A recent report from the Brookings Institution pointed to Chinese tobacco’s political connections: the brother of incoming executive vice premier Li Keqiang has been the deputy director of the State Tobacco Monopoly Administration since 2003.

Besides the tacit state support, there are demographic factors at work. Cigarettes are still a common gift, especially in business relationships, where most meetings end with a round of gift-giving. And women, who traditionally have not smoked in China, are picking up the habit far faster than men.

The result is a shocking rise in chronic obstructive pulmonary disease and lung cancer. Donald Sin of the University of British Columbia projects that by 2030, COPD will kill 3 million Chinese people a year. In November, the Beijing Health Bureau said that lung cancer had jumped 56 percent in the ten years from 2001 to 2010.

Of course, smoking is just part of what’s ruining the lungs of the Chinese: A study published by Peking University and Greenpeace in December pointed to as many as 8,572 premature deaths caused by air pollution in 2012, and that figure came from of survey of just four major Chinese cities.

One glimmer of hope appears with China’s new leadership. Peng Liyuan, the folk singer wife of new party secretary Xi Jingping, is reported to be an ambassador for the Chinese Association on Tobacco Control. But since China’s new first lady has been chiefly out of the public eye after her husband’s rise, it doesn’t appear likely she’ll take on any Michelle Obama-like projects to encourage healthier living.

Top image: A man holds a lighter to light a cigarette as another man smokes a cigarette on a street in Shanghai. (Aly Song, Reuters)